Health insurance or Medicaid said no in South Carolina? Deadlines and free help
In South Carolina, your health plan is regulated by South Carolina Department of Insurance (SCDOI), Consumer Services Division, if it is a state-regulated plan.
South Carolina runs its own independent review of denials: External review (Health Carrier External Review Act). You generally have 4 months to ask for it.
External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.
Pick your plan type
Which kind of coverage was denied? The plan type decides which rules and deadlines apply.
Insurance I bought or got through work
Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.
My employer pays claims itself (self-funded)
Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.
Healthy Connections Medicaid
You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.
Marketplace (HealthCare.gov) decision
A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.
Checked against official sources: October 30, 2026.
Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.
How long do I have in South Carolina?
- Appeal to your plan
- At least 180 days from receipt of the denial (federal rule)
- Outside review
- 4 months
- Hearing deadline
- 30 days
- Appeal to the plan first
- 60 days (federal rule)
- Appeal deadline – HealthCare.gov
- 90 days (federal rule)
How do I know which plan type I have?
- South Carolina Department of Insurance (SCDOI), Consumer Services Division · 1-800-768-3467 · Complaint form
Health insurance policies and HMO plans sold in South Carolina, including insured employer plans and the State Health Plan for some rules. Not self-funded employer plans (ERISA).
How to tell which agency regulates your plan
South Carolina's external review law does not apply to self-funded employer plans covered by ERISA; those follow federal rules.
Law: S.C. Code 38-71-1930(B)
Step 1: Appeal to your plan in South Carolina
What it is called: Internal appeal
South Carolina does not add its own internal appeal deadlines for most plans; the federal rules apply. If your insurer does not decide your internal appeal on time (after it has all the information it needs and you did not agree to a delay), you are treated as having finished the internal appeal and can ask for external review.
Law: S.C. Code 38-71-1960(A)(2); SCDOI Bulletin 2011-04
Step 2: Outside review in South Carolina
External review (Health Carrier External Review Act)
Deadline to ask: 4 months.
Urgent care in South Carolina: faster decisions
Outside review
If your treating doctor certifies that you have a serious medical condition that needs immediate treatment, or you got emergency care and have not been discharged, you can ask for an expedited external review. The decision must come within 72 hours of the request. If you have stage four advanced, metastatic cancer and your plan denies a recognized diagnostic imaging service as not medically necessary, you have a right to an expedited external review.
Law: S.C. Code 38-71-144
Standard: 45 days; Urgent: 72 hours
Medicaid
You can ask for an expedited appeal when you file or later. State that you want an expedited appeal and why, through the Appeals website, fax, email or mail, and send supporting documents. SCDHHS grants it if the standard timeframe could jeopardize your life, health or ability to attain, maintain or regain maximum function.
Complaints about your plan in South Carolina
For other problems with an insurer, you can file a complaint with the South Carolina Department of Insurance online or with its Consumer Complaint Form, or call the Consumer Services Division at 803-737-6180 or 1-800-768-3467.
Medicaid (Healthy Connections Medicaid (South Carolina Medicaid)) denials in South Carolina
Who holds the hearing: SCDHHS Office of Appeals and Hearings.
Hearing deadline: 30 days
Marketplace decisions in South Carolina
South Carolina uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.
Other rights in South Carolina
Expedited review for stage four cancer imaging
If your plan covers treatment of stage four advanced, metastatic cancer and denies prior authorization or a claim for a recognized diagnostic imaging service as not medically necessary, you have a right to an expedited external review. This also applies to the State Health Plan.
Law: S.C. Code 38-71-144
Medicaid hearing decision can go to court
If you disagree with the SCDHHS hearing officer's order, you can appeal to the South Carolina Administrative Law Court within 30 days of receiving the order.
How long do I have? Deadline calculator
Pick your plan type and enter the dates on your notice. We count from the rules in South Carolina and the federal rules.
Write my appeal: free letters
Free help in South Carolina
- South Carolina Department of Insurance, Consumer Services Division · 1-800-768-3467
Listed by HHS for questions about insurance you bought yourself or through an employer that does business only in South Carolina; your denial notice must include its phone number for help with external review. - South Carolina Legal Services · 1-888-346-5592
- LawHelp.org/SC
- SCDHHS Office of Appeals and Hearings · 1-800-763-9087
- CMS help page for this state
- LawHelp.org
- Your state's Consumer Assistance Program (CAP) or insurance department
- U.S. Department of Labor, Employee Benefits Security Administration (EBSA) · 1-866-444-3272
- HealthCare.gov Marketplace Call Center and local help · 1-800-318-2596
- CCIIO Health Insurance Assistance Team · 1-888-393-2789
- Legal Services Corporation (LSC) - Find legal aid
Good to know in South Carolina
- In South Carolina you send your external review request to your insurer, not to the state; the insurer notifies the Department of Insurance, which assigns the reviewer (SCDOI Bulletin 2011-04).
- South Carolina Medicaid notices usually give only 30 days to appeal, from the date of the notice or from the day you receive it (SCDHHS, File an Appeal).
- South Carolina Medicaid fair hearings are held in person, not by phone (SCDHHS, File an Appeal).
Questions about appeals in South Carolina
How long do I have to appeal a health insurance denial in South Carolina?
State law does not set a longer time. Use the deadline on your denial notice; federal rules give at least 180 days for most plans. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.
How do I get an outside (external) review in South Carolina?
External review (Health Carrier External Review Act). Ask your health insurer in writing (at the address in your denial notice). Include a signed medical records release form and, for experimental or investigational denials, your doctor's certification.
Is outside review free in South Carolina?
The review costs you nothing. The insurer pays for the external review.
How long do I have to ask for a Medicaid fair hearing in South Carolina?
30 days. The date of the notice, or the day you receive it, as stated on your notice
Can I keep my Medicaid benefits while I appeal in South Carolina?
You may ask for your benefits or services to continue if you ask within 10 days of the date on the notice. New services cannot be started.
Who regulates health insurance in South Carolina?
South Carolina Department of Insurance (SCDOI), Consumer Services Division. South Carolina's external review law does not apply to self-funded employer plans covered by ERISA; those follow federal rules.
Not about a denied claim?
Nearby states
Sources
- S.C. Code Title 38, Chapter 71 (incl. 38-71-144 and Article 19, Health Carrier External Review Act)
- SCDOI Bulletin 2011-04, Compliance with the External Review Requirements of PPACA
- SCDOI, External Reviews - Independent Review Organizations
- SCDOI, Consumer Services
- SCDHHS, File an Appeal
- CMS CCIIO, South Carolina Consumer Assistance